Psychiatry at crossroads yet again: social policies must lead the way.

The global burden of mental and substance use disorders is rising at an unprecedented rate worldwide, driven by a complex and evolving network of social determinants. Mental health policies are predominantly rooted in biomedical frameworks and interventions, partially considering the crucial social, economic, and political factors that fundamentally shape mental health outcomes. Thus, policy responses often emphasize individualized, symptom-focused treatments, primarily psychopharmacological, while overlooking structural inequities. A paradigm shift is imperative: mental health policies must integrate social justice, equity, and community empowerment as foundational, evidence-based components of psychiatric care. And if psychiatry is to survive, then psychiatrists must be at the forefront of this revolution, as advocates and campaigners, alongside patients and their care partners. Embedding social determinants into psychiatric training, service design, and policymaking is not merely contextual enhancement, it is a moral and scientific necessity. Participation of people with lived experience, transparent governance, ring-fenced funding, and regular rights compliance audits are all crucial for a socially- oriented mental health plan.